Read this and you may never eat chicken again

Most meat animals are raised with the assistance of daily doses of antibiotics. By 2050, antibiotic resistance will cause a staggering 10 million deaths a year

Every year I spend some time in a tiny apartment in Paris, seven stories above the mayors offices for the 11th arrondissement. The Place de la Bastille the spot where the French revolution sparked political change that transformed the world is a 10-minute walk down a narrow street that threads between student nightclubs and Chinese fabric wholesalers.

Twice a week, hundreds of Parisians crowd down it, heading to the march de la Bastille, stretched out along the center island of the Boulevard Richard Lenoir.

Blocks before you reach the market, you can hear it: a low hum of argument and chatter, punctuated by dollies thumping over the curbstones and vendors shouting deals. But even before you hear it, you can smell it: the funk of bruised cabbage leaves underfoot, the sharp sweetness of fruit sliced open for samples, the iodine tang of seaweed propping up rafts of scallops in broad rose-colored shells.

Threaded through them is one aroma that I wait for. Burnished and herbal, salty and slightly burned, it has so much heft that it feels physical, like an arm slid around your shoulders to urge you to move a little faster. It leads to a tented booth in the middle of the market and a line of customers that wraps around the tent poles and trails down the market alley, tangling with the crowd in front of the flower seller.

In the middle of the booth is a closet-size metal cabinet, propped up on iron wheels and bricks. Inside the cabinet, flattened chickens are speared on rotisserie bars that have been turning since before dawn. Every few minutes, one of the workers detaches a bar, slides off its dripping bronze contents, slips the chickens into flat foil-lined bags, and hands them to the customers who have persisted to the head of the line.

I can barely wait to get my chicken home.

Chickens
Chickens roam in an outdoor enclosure of a chicken farm in Vielle-Soubiran, south-western France. Photograph: Iroz Gaizka/AFP/Getty Images


The skin of a poulet crapaudine named because its spatchcocked outline resembles a crapaud, a toad shatters like mica; the flesh underneath, basted for hours by the birds dripping on to it from above, is pillowy but springy, imbued to the bone with pepper and thyme.

The first time I ate it, I was stunned into happy silence, too intoxicated by the experience to process why it felt so new. The second time, I was delighted again and then, afterward, sulky and sad.

I had eaten chicken all my life: in my grandmothers kitchen in Brooklyn, in my parents house in Houston, in a college dining hall, friends apartments, restaurants and fast food places, trendy bars in cities and old-school joints on back roads in the south. I thought I roasted a chicken pretty well myself. But none of them were ever like this, mineral and lush and direct.

I thought of the chickens Id grown up eating. They tasted like whatever the cook added to them: canned soup in my grandmothers fricassee, her party dish; soy sauce and sesame in the stir fries my college housemate brought from her aunts restaurant; lemon juice when my mother worried about my fathers blood pressure and banned salt from the house.

This French chicken tasted like muscle and blood and exercise and the outdoors. It tasted like something that it was too easy to pretend it was not: like an animal, like a living thing. We have made it easy not to think about what chickens were before we find them on our plates or pluck them from supermarket cold cases.

I live, most of the time, less than an hours drive from Gainesville, Georgia, the self-described poultry capital of the world, where the modern chicken industry was born. Georgia raises 1.4bn broilers a year, making it the single biggest contributor to the almost 9bn birds raised each year in the United States; if it were an independent country, it would rank in chicken production somewhere near China and Brazil.

Yet you could drive around for hours without ever knowing you were in the heart of chicken country unless you happened to get behind a truck heaped with crates of birds on their way from the remote solid-walled barns they are raised in to the gated slaughter plants where they are turned into meat. That first French market chicken opened my eyes to how invisible chickens had been for me, and after that, my job began to show me what that invisibility had masked.

My house is less than two miles from the front gate of the Centers for Disease Control and Prevention, the federal agency that sends disease detectives racing to outbreaks all over the world. For more than a decade, one of my obsessions as a journalist has been following them on their investigations and in long late-night conversations in the United States and Asia and Africa, with physicians and veterinarians and epidemiologists, I learned that the chickens that had surprised me and the epidemics that fascinated me were more closely linked than I had ever realized.

I discovered that the reason American chicken tastes so different from those I ate everywhere else was that in the United States, we breed for everything but flavor: for abundance, for consistency, for speed. Many things made that transformation possible.

But as I came to understand, the single biggest influence was that, consistently over decades, we have been feeding chickens, and almost every other meat animal, routine doses of antibiotics on almost every day of their lives.

Caged
Caged battery hens in a chicken farm in Catania, Sicily. Photograph: Fabrizio Villa/AFP/Getty Images

Antibiotics do not create blandness, but they created the conditions that allowed chicken to be bland, allowing us to turn a skittish, active backyard bird into a fast-growing, slow-moving, docile block of protein, as muscle-bound and top-heavy as a bodybuilder in a kids cartoon. At this moment, most meat animals, across most of the planet, are raised with the assistance of doses of antibiotics on most days of their lives: 63,151 tons of antibiotics per year, about 126m pounds.

Farmers began using the drugs because antibiotics allowed animals to convert feed to tasty muscle more efficiently; when that result made it irresistible to pack more livestock into barns, antibiotics protected animals against the likelihood of disease. Those discoveries, which began with chickens, created what we choose to call industrialized agriculture, a poultry historian living in Georgia proudly wrote in 1971.

Chicken prices fell so low that it became the meat that Americans eat more than any other and the meat most likely to transmit food-borne illness, and also antibiotic resistance, the greatest slow-brewing health crisis of our time.

For most people, antibiotic resistance is a hidden epidemic unless they have the misfortune to contract an infection themselves or have a family member or friend unlucky enough to become infected.

Drug-resistant infections have no celebrity spokespeople, negligible political support and few patients organizations advocating for them. If we think of resistant infections, we imagine them as something rare, occurring to people unlike us, whoever we are: people who are in nursing homes at the end of their lives, or dealing with the drain of chronic illness, or in intensive-care units after terrible trauma. But resistant infections are a vast and common problem that occur in every part of daily life: to children in daycare, athletes playing sports, teens going for piercings, people getting healthy in the gym.

And though common, resistant bacteria are a grave threat and getting worse.

They are responsible for at least 700,000 deaths around the world each year: 23,000 in the United States, 25,000 in Europe, more than 63,000 babies in India. Beyond those deaths, bacteria that are resistant to antibiotics cause millions of illnesses 2m annually just in the United States and cost billions in healthcare spending, lost wages and lost national productivity.

It is predicted that by 2050, antibiotic resistance will cost the world $100tn and will cause a staggering 10m deaths per year.

Disease organisms have been developing defenses against the antibiotics meant to kill them for as long as antibiotics have existed. Penicillin arrived in the 1940s, and resistance to it swept the world in the 1950s.

Tetracycline arrived in 1948, and resistance was nibbling at its effectiveness before the 1950s ended. Erythromycin was discovered in 1952, and erythromycin resistance arrived in 1955. Methicillin, a lab-synthesized relative of penicillin, was developed in 1960 specifically to counter penicillin resistance, yet within a year, staph bacteria developed defenses against it as well, earning the bug the name MRSA, methicillin-resistant Staphylococcus aureus.

After MRSA, there were the ESBLs, extended-spectrum beta-lactamases, which defeated not only penicillin and its relatives but also a large family of antibiotics called cephalosporins. And after cephalosporins were undermined, new antibiotics were achieved and lost in turn.

Each time pharmaceutical chemistry produced a new class of antibiotics, with a new molecular shape and a new mode of action, bacteria adapted. In fact, as the decades passed, they seemed to adapt faster than before. Their persistence threatened to inaugurate a post-antibiotic era, in which surgery could be too dangerous to attempt and ordinary health problems scrapes, tooth extractions, broken limbs could pose a deadly risk.

For a long time, it was assumed that the extraordinary unspooling of antibiotic resistance around the world was due only to misuse of the drugs in medicine: to parents begging for the drugs even though their children had viral illnesses that antibiotics could not help; physicians prescribing antibiotics without checking to see whether the drug they chose was a good match; people stopping their prescriptions halfway through the prescribed course because they felt better, or saving some pills for friends without health insurance, or buying antibiotics over the counter, in the many countries where they are available that way and dosing themselves.

But from the earliest days of the antibiotic era, the drugs have had another, parallel use: in animals that are grown to become food.

Eighty percent of the antibiotics sold in the United States and more than half of those sold around the world are used in animals, not in humans. Animals destined to be meat routinely receive antibiotics in their feed and water, and most of those drugs are not given to treat diseases, which is how we use them in people.

Instead, antibiotics are given to make food animals put on weight more quickly than they would otherwise, or to protect food animals from illnesses that the crowded conditions of livestock production make them vulnerable to. And nearly two-thirds of the antibiotics that are used for those purposes are compounds that are also used against human illness which means that when resistance against the farm use of those drugs arises, it undermines the drugs usefulness in human medicine as well.

Caged
Caged chickens in San Diego, California. California voters passed a new animal welfare law in 2008 to require that the states egg-laying hens be given room to move. Photograph: Christian Science Monitor/Getty Images

Resistance is a defensive adaptation, an evolutionary strategy that allows bacteria to protect themselves against antibiotics power to kill them. It is created by subtle genetic changes that allow organisms to counter antibiotics attacks on them, altering their cell walls to keep drug molecules from attaching or penetrating, or forming tiny pumps that eject the drugs after they have entered the cell.

What slows the emergence of resistance is using an antibiotic conservatively: at the right dose, for the right length of time, for an organism that will be vulnerable to the drug, and not for any other reason. Most antibiotic use in agriculture violates those rules.

Resistant bacteria are the result.


Antibiotic resistance is like climate change: it is an overwhelming threat, created over decades by millions of individual decisions and reinforced by the actions of industries.

It is also like climate change in that the industrialized west and the emerging economies of the global south are at odds. One quadrant of the globe already enjoyed the cheap protein of factory farming and now regrets it; the other would like not to forgo its chance. And it is additionally like climate change because any action taken in hopes of ameliorating the problem feels inadequate, like buying a fluorescent lightbulb while watching a polar bear drown.

But that it seems difficult does not mean it is not possible. The willingness to relinquish antibiotics of farmers in the Netherlands, as well as Perdue Farms and other companies in the United States, proves that industrial-scale production can be achieved without growth promoters or preventive antibiotic use. The stability of Masadour and Lou and White Oak Pastures shows that medium-sized and small farms can secure a place in a remixed meat economy.

Whole Foods pivot to slower-growing chicken birds that share some of the genetics preserved by Frank Reese illustrates that removing antibiotics and choosing birds that do not need them returns biodiversity to poultry production. All of those achievements are signposts, pointing to where chicken, and cattle and hogs and farmed fish after them, need to go: to a mode of production where antibiotics are used as infrequently as possible to care for sick animals, but not to fatten or protect them.

That is the way antibiotics are now used in human medicine, and it is the only way that the utility of antibiotics and the risk of resistance can be adequately balanced.

Excerpted from Big Chicken by Maryn McKenna published by National Geographic on 12 September 2017. Available wherever books are sold.

Plucked! The Truth About Chicken by Maryn McKenna is published in the UK by Little, Brown and is now available in eBook @14.99, and is published in Trade Format @14.99 on 1 February 2018.

Read more: https://www.theguardian.com/lifeandstyle/2017/oct/13/can-never-eat-chicken-again-antibiotic-resistance

Rule that patients must finish antibiotics course is wrong, study says

Experts suggest patients should stop taking the drugs when they feel better rather than completing their prescription

Telling patients to stop taking antibiotics when they feel better may be preferable to instructing them to finish the course, according to a group of experts who argue that the rule long embedded in the minds of doctors and the public is wrong and should be overturned.

Patients have traditionally been told that they must complete courses of antibiotics, the theory being that taking too few tablets will allow the bacteria causing their disease to mutate and become resistant to the drug.

But Martin Llewelyn, a professor in infectious diseases at Brighton and Sussex medical school, and colleagues claim that this is not the case. In an analysis in the British Medical Journal, the experts say the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.

There are some diseases where the bug can become resistant if the drugs are not taken for long enough. The most obvious example is tuberculosis, they say. But most of the bacteria that cause people to become ill are found on everybodys hands in the community, causing no harm, such as E coli and Staphylococcus aureus. People fall ill only when the bug gets into the bloodstream or the gut. The longer such bacteria are exposed to antibiotics, the more likely it is that resistance will develop.

The experts say there has been too little research into the ideal length of a course of antibiotics, which also varies from one individual to the next, depending in part on what antibiotics they have taken in the past.

In hospital, patients can be tested to work out when to stop the drugs. Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, they say. That, they add, is in direct contravention of World Health Organisation advice.

Other experts in infectious diseases backed the group. I have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms, said Peter Openshaw, president of the British Society for Immunology.

This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous. Far from being irresponsible, shortening the duration of a course of antibiotics might make antibiotic resistance less likely.

Alison Holmes, a professor of infectious diseases at Imperial College London, said a great British authority, Prof Harold Lambert, had made the same point in a Lancet article entitled Dont keep taking the tablets as early as 1999. It remains astonishing that apart from some specific infections and conditions, we still do not know more about the optimum duration of courses or indeed doses in many conditions, yet this dogma has been pervasive and persistent.

Jodi Lindsay, a professor of microbial pathogenesis at St Georges, University of London, said it was sensible advice. The evidence for completing the course is poor, and the length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies, she said. The evidence for shorter courses of antibiotics being equal to longer courses, in terms of cure or outcome, is generally good, although more studies would help and there are a few exceptions when longer courses are better for example, TB.

But the Royal College of GPs expressed concerns. Recommended courses of antibiotics are not random, said its chair, Prof Helen Stokes-Lampard. They are tailored to individual conditions and in many cases, courses are quite short for urinary tract infections, for example, three days is often enough to cure the infection.

We are concerned about the concept of patients stopping taking their medication midway through a course once they feel better, because improvement in symptoms does not necessarily mean the infection has been completely eradicated. Its important that patients have clear messages and the mantra to always take the full course of antibiotics is well known. Changing this will simply confuse people.

The UKs chief medical officer, Prof Dame Sally Davies, said: The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them.

[The National Institute for Health and Care Excellence] is currently developing guidance for managing common infections, which will look at all available evidence on appropriate prescribing of antibiotics.

The Department of Health will continue to review the evidence on prescribing and drug-resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.

Read more: https://www.theguardian.com/society/2017/jul/26/rule-patients-must-finish-antibiotics-course-wrong-study-says

Untreatable gonorrhoea ‘superbug’ spreading around world, WHO warns

World Health Organization tells of very serious situation after confirming three known cases where all antibiotics were ineffective


The World Health Organization has warned of the spread of totally untreatable strains of gonorrhoea after discovering at least three people with the superbug.

Giving details of studies showing a very serious situation with regard to highly drug-resistant forms of the sexually transmitted disease (STD), WHO experts said on Friday it was only a matter of time before last-resort gonorrhoea antibiotics would be of no use.

Gonorrhoea is a very smart bug, said Teodora Wi, a human reproduction specialist at the Geneva-based UN health agency. Every time you introduce a new type of antibiotic to treat it, this bug develops resistance to it.

The WHO estimates 78 million people a year get gonorrhoea, an STD that can infect the genitals, rectum and throat.

The infection, which in many cases has no symptoms on its own, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility, as well as increasing the risk of getting HIV.

Wi, who gave details in a telephone briefing of two studies on gonorrhoea published in the journal PLOS Medicine, said one had documented three specific cases one each in Japan, France and Spain of patients with strains of gonorrhoea against which no known antibiotic is effective.

These are cases that can infect others. It can be transmitted, she told reporters. And these cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common.

The WHOs programme for monitoring trends in drug-resistant gonorrhoea found in a study that from 2009 to 2014 there was widespread resistance to the first-line medicine ciprofloxacin, increasing resistance to another antibiotic drugs called azithromycin, and the emergence of resistance to last-resort treatments known as extended-spectrum cephalosporins (ESCs).

In most countries, it said, ESCs are now the only single antibiotics that remain effective for treating gonorrhoea. Yet resistance to them has already been reported in 50 countries.

Manica Balasegaram, director of the Global Antibiotic Research and Development Partnership, said the situation was grim and there was a pressing need for new medicines.

The pipeline, however, is very thin, with only three potential new gonorrhoea drugs in development and no guarantee any will prove effective in final-stage trials, he said.

We urgently need to seize the opportunities we have with existing drugs and candidates in the pipeline, he said. Any new treatment developed should be accessible to everyone who needs it, while ensuring it is used appropriately, so that drug resistance is slowed as much as possible.

Read more: https://www.theguardian.com/society/2017/jul/07/untreatable-gonorrhoea-superbug-spreading-around-world-who-warns

Health report links antibiotics to risk of miscarriage

Canadian study finds taking the drugs raises chances of having a miscarriage by between 60% and 100%

Many common antibiotics may double the risk of miscarriage in early pregnancy, research has shown.

A Canadian study has found that taking the drugs raised the chances of having a miscarriage by between 60% and 100%.

The link was seen with several classes of antibiotic including macrolides, quinolones, tetracyclines, sulphonamides and metronidazole. However, nitrofurantoin, often used to treat urinary tract infections in pregnant women, had no effect on miscarriage risk. Nor did the widely used antibiotic erythromycin.

The researchers looked at data from almost 9,000 cases of miscarriage at an average time of 14 weeks into pregnancy, involving girls and women aged between 15 and 45.

The study leader, Dr Anick Brard, from the University of Montreal in Quebec, said: Infections are prevalent during pregnancy. Although antibiotic use to treat infections has been linked to a decreased risk of prematurity and low birth weight in other studies, our investigation shows that certain types of antibiotics are increasing the risk of spontaneous abortion, with a 60% to two-fold increased risk.

Women who miscarried were more likely to be older, living alone, and to have multiple health issues and infections. But all these factors were accounted for in the analysis, whose findings are published in the Canadian Medical Association Journal.

Dr Brard added: The increased risk was not seen for all antibiotics, which is reassuring for users, prescribers and policymakers.

The researchers identified a total of 182,369 pregnancies from the Quebec pregnancy cohort, a large population group from the province providing data for ongoing studies. Of these, 8,702 (4.7%) ended with an early miscarriage.

Writing in the journal, the team concluded that there was a link between some antibiotics and an increased risk of miscarriage, but added: However, residual confounding by severity of infection cannot be ruled out.

Read more: https://www.theguardian.com/society/2017/may/02/health-report-links-antibiotics-to-risk-of-miscarriage